Background. The purpose of this study was to determine how much and in
what ways family physicians' time at work is affected by the presence
of a medical student in the practice. Methods. The study included wor
k sampling of 22 nonacademic family physicians, each observed during 1
day with and 1 day without a medical student, and 12 academic family
physicians, of whom nine were observed for 8 half-days and three for 2
or 4 half-days of clinical practice. Observations were made on averag
e every 4 minutes at preselected random times during the workday. Resu
lts. When a student was present at the practice, the amount of time pr
ivate physicians actually spent working increased by 52 minutes per da
y, and their patient-care productivity decreased from 3.9 to 3.3 patie
nts per hour. There was no significant change in time spent at work fo
r academic physicians. With a student present, the physicians in priva
te practice spent 27 fewer minutes per day in patient-care activities,
whereas academic physicians spent 47.5 fewer minutes per day in these
activities. Private and academic physicians spent 71 and 63 minutes p
er day, respectively, in student-centered activities. There were few d
ifferences bens een physician groups in how this direct teaching time
was used. Conclusions. when a student is in the practice, private fami
ly physicians shift substantial amounts of work time from patient-cent
ered to student-centered activities. They also use their personal time
for teaching activities and experience a decrease in patient-care pro
ductivity of 0.6 patients per hour.